Background

Trauma-informed parenting interventions have been used in child welfare to help caregivers respond to children in trauma-informed ways that can mitigate the effects of maltreatment and build strong caregiver-child relationships. Existing studies support their effectiveness with children and youth involved in the child welfare system. However, to further advance the effectiveness of evidenced-based intervention for child welfare populations, one key step is to identify subgroups of individuals who have different intervention responses or outcomes.

Objective

To identify pre-treatment moderators that can distinguish subgroups of caregivers and children who benefit differently from an intervention.

Participants and setting

414 children in foster care (age 3 or younger) and their caregivers (birth, adoptive, kin, and nonkin) were randomly assigned to receive a trauma-informed parenting intervention in the Illinois Birth through Three Title IV-E waiver demonstration or foster care services as usual.

Methods

Model-based Recursive Partitioning (MOB) was used to identify treatment moderators and moderator interactions. MOB fits a parametric model and uses a data-driven method to find subgroups for which the specified parametric model has different parameters. Two parametric models (logistic and linear regression) were used in accordance with two outcomes: reunification (binary) and caregiver-child attachment (continuous). We examined 21 potential pre-treatment moderators in both models.

Results

For the reunification outcome, the MOB produced the following three treatment moderators, which identified subgroups of participants who responded differently to the intervention: (a) caregivers’ relationship with the child (kin vs. non-kin/permanent caregivers), (b) caregiver-child attachment, and (c) case history of physical abuse. For the attachment outcome, caregivers’ age was found to be a treatment moderator. Future developments of trauma-informed interventions should consider these moderators.

中文翻译：

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确定对寄养儿童进行创伤知情育儿干预的治疗调节器：使用基于模型的递归分区

背景

创伤知情育儿干预已被用于儿童福利，以帮助照顾者以创伤知情的方式应对儿童，以减轻虐待的影响并建立牢固的照顾者与儿童的关系。现有研究支持其对参与儿童福利系统的儿童和青年的有效性。然而，为了进一步提高循证干预对儿童福利人群的有效性，一个关键步骤是确定具有不同干预反应或结果的个体亚群。

客观的

确定可以区分从干预中获益不同的照料者和儿童亚组的治疗前调节器。

参与者和设置

414 名寄养儿童（3 岁或以下）及其照料者（出生、收养、亲属和非亲属）被随机分配到伊利诺伊州出生时通过三个 Title IV-E 豁免示范或寄养接受创伤知情育儿干预服务照常。

方法

基于模型的递归分区 (MOB) 用于识别治疗调节器和调节器交互。MOB 拟合参数模型并使用数据驱动的方法来查找指定参数模型具有不同参数的子组。根据两个结果使用两个参数模型（逻辑回归和线性回归）：重新统一（二元）和照顾者-儿童依恋（连续）。我们在两种模型中检查了 21 种潜在的治疗前调节剂。

结果

对于团聚结果，MOB 产生了以下三个治疗调节器，它们确定了对干预有不同反应的参与者亚组：(a) 照顾者与孩子的关系（亲属与非亲属/永久照顾者），(b)照料者与儿童之间的依恋，以及 (c) 身体虐待的病史。对于依恋结果，发现看护人的年龄是治疗调节因素。创伤知情干预的未来发展应考虑这些调节因素。